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nosonew BSN, RN

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nosonew's Latest Activity

  1. nosonew

    mileage guidelines

    Luckily, No. We do document where, how long, miles, etc, but have never been questioned. I totally depends on the traffic, weather, etc.
  2. Okay... new hospice nurse (RN since 93 however) and having difficulty transitioning from curative to palliative care. (imagine that!) Pain control: What do you most commonly use? Do you ever fear using too much Roxanol? How do you explain the difference between Roxanol and Morphine Sulfate? Our Medical Director tells me they are TOTALLY different drugs. Yet they are both MS, so I do not understand this. Yes, I know Roxanol is stronger... but that isn't what he meant. Bowel regime: What do you do when you get a patient (new admit) and apparently he/she hasn't had a bm in 7-10 days? (eek!) Is unable to tell you.. and facility he has been at "hasn't paid attention?" (eek!) What would you have done? Ordered? Skin Care: What products do you use most frequently for skincare and decubs? Last but not least... (boohoo) HOW do I get supplies that I would LIKE to use, but aren't on in stock (perhaps expensive)??? And I work for a non-profit... (eek!) Help!
  3. nosonew

    Concerned about new widow... she is VERY angry

    Actually, I was a bit more concerned about what she might do to the oncologist than to herself. However, UPDATE... spoke with her at length today. She sounds better and she and I do get along very well. She told me our bereavement counselor "sucked" and if he would "quit beating around the bush and just state it like it is they MAY have gotten somewhere". She is open to suggestions and she and I are going to get together next week for lunch to talk about her feelings. We need to talk about her mother (on hospice also) as she has some medical issues and daughter is POA. So... I think we are on the right track right now.. and I am going to keep in close contact as I can. I am NOT going to contact the sons at this time. At least not without her permission, which I plan to ask her next week for. She did actually tell me on the phone today that she is still "angry as hell" but doesn't feel like killing anyone anymore as that won't bring her husband back. (whew). I think her anger stage is moving forward...and onward we go. Thanks for the advice ladies!
  4. Her husband died after a very short battle with cancer. The oncologist told them due to his liver function that chemo would kill him, but he did do radiation. However, the cancer spread and within 3 months he died. They were just about to retire and travel. Now, the wife is very angry, making threats against the oncologist, stating he didn't give them the option to do chemo and it was their right to choose. She has called the oncologist and written him letters. She talked to our bereavement counselor once, then told him he should look at a different line of work. She refuses to see a therapist. Is it appropriate to call her grown sons and voice my concerns without giving out all of the info? I am really concerned about her and also just found out her youngest son was just diagnosed with cancer. And her mother is dying. I don't think she can take anymore. What to do???? I am taking care of her mother and I also took care of her husband during his last weeks, so I have met the sons.
  5. nosonew

    Can a patient do chemo or radiation?

    We pay for all meds associated with their hospice dx. Including any comfort care items (ie: bowel, bladder, depression, pain, etc. of course) The thrift shop is in a rented building on our main street. They take donations, have volunteers that come in M-W to go thru the items, price, etc. It is open Thu-Fri-Sat. It is all based on donated items and volunteers. All monies go to help with hospice expenses. I think they opened it because so many families lived out of town and didn't know what to do with the clothing, nik-naks, recipe books, crafts, Xmas items, etc... Occas. they get furniture. Lots of kitchen things. Luckily, we nurses can use it for our patients needs as well. If a client with no money has a broken crock pot or coffee pot... we can go in there and get one for free. There is also a volunteer who checks everything electrical for frayed cords, if it works, etc.
  6. nosonew

    Can a patient do chemo or radiation?

    We currently have 58 patients. We live in a rural community and cover many counties. Luckily, we do have many donations and many/most of our clients do memorials to our hospice which helps make payroll (that is paid after paying medical bills of course!) and we also opened a hospice thrift shop with all donated items and that money is also used to pay for things patients need but are not covered. I love love love my job... I wish I could win the lottery and donate half of it and work for free. Honestly. Until last year, I have been told this hospice paid for all medications for all clients. They are still sad they can't keep doing that, but medications are just too expensive.
  7. nosonew

    Can a patient do chemo or radiation?

    So more or less it depends on the Hospice Organization itself? The hospice I work for is non profit and allows this... yet I have a friend across the US that can not find a hospice to help with her 80 yoa MIL who has terminal ca but needs palliative radiation. I have encouraged her to speak to other hospice organizations in her area. Thanks!
  8. And still be considered a hospice patient? I am wondering because those can both be done for comfort care, to keep the size of the tumor from growing, thus allowing increased comfort. I am new to hospice nursing and confused! Help!
  9. nosonew

    Do you use 2 Bags of NS or 1?

    We are Davita...Kansas and we were told it is a new procedure for safety measures. Also helps to not run dry too!
  10. nosonew

    Do you use 2 Bags of NS or 1?

    Our new procedure is 3 bags. One to prime, One to test, One to Run. Yep.
  11. nosonew

    How much do your PCT's do?

    1. If you don't know (therefore can't trust) your PCT... YOU draw up all meds you give. Period. Just say this.. "I need to learn this..can you show me how to do it?" AND say..."To make your life easier..I will just draw up all the meds my patients need... :)" with a smile.. let them know you are making THEIR job easier! 2. B&T.. As Jnette said what bruit and thrill are. HOWEVER, we listen regardless no matter what. And guess what? When you listen EVERY time...when they begin to get a stricture...you HEAR it before it clots off! YEP! You hear this high pitched swishing sound vs. the regular sound... and when YOU get to know the patients access...you will know what is going on with them! Prevention is a HUGE aspect to ALL nursing...not just dialysis! :) Read your P&P's...even if you have to do it on your breaks...take them home, etc. READ THEM! Make copies of those most pertinent to you and read them often! YOUR license is on the line! NEVER document ANYTHING YOU PERSONALLY DID NOT DO! That is against your own nursing rules. Read your own state's licensing info... I guarantee that is considered falsifying documentation and you CAN lose your license doing that! Your company doesn't want you to do it! Those you work with just find it the easiest way to do it! UH..NO! Do you have a stethoscope? Do they provide one for you? I suggest you BUY a good one for yourself for around 100.00. At tax time, write that off as a work expense (keep your receipt!). Keep the questions coming... Good luck! Geez... I should pm you my phone #! If you want to talk, pm me...I will call you!
  12. nosonew

    Nurses Mixing Meds

    Can you be more specific? What meds are being put in the dialysate?
  13. nosonew

    Considering career change to dialysis

    I they need a nurse...they can start you at at LEAST 23.00 hr... minimum. Fresenius is fine... Good luck!
  14. nosonew

    Maximum UF limit for hemo patients

    Our medical dir. lets us set the max UF rate... usually 2 max! Most can't tolerate more than 1.5/hr. You just get to know the patient and what they can and cannot tolerate. Good luck!
  15. nosonew


    I heard that ALL dialysis units in the area did their best to move their patients elsewhere PRIOR to the hurricane. Of course, as you know, we can't force our patients to do anything. I am sure all outside HD units will take any and all...although currently..without hemo for a week or so, they are all likely currently hospitalized for acute daily dialysis.
  16. nosonew

    Have decided to leave dialysis after 6.5 years...

    Impossible to remember everyone's questions...comments but I will try. Bloodmonster... sorry you had that experience. I don't and haven't and WON'T work acutes.. can't be on call with my little ones :chuckle but I feel bad the nurse didn't even try to get to know you first... Nitengale... EXACTLY! I am a PATIENT FIRST nurse... and I graduated in 93! I didn't even know I was like the Watson philosophy until this past year! I love my patients... all 26 living, all 40+ dead now. Too many funerals (YES, I was the ONLY staff member that went to them ALL..if at all possible given WORK schedule). So...I think I have been to 30+...My co-workers are all into their bonuses... regardless of how that affects the patients.. it makes me ill! BSN grad... I have yet to know a patient who faked their cramps to get off early. Or faked anything for any reason. WHY? Because I have always instilled in my patients that THEIR life/comfort/wellbeing/sanity COMES FIRST. If they need off early...FOR WHATEVER reason... FINE!It is THEIR life...their body... THEIR RIGHT! THAT is the difference between myself and the other nurses... they force time on them... regardless of reason. I choose to educate and let them make EDUCATED decisions that are best for THEM. Jessica... THANKS! Renerian... Considered it! can't do it with young children at home! NO WAY! Thanks for the thought though! jnette... I realize you and I are the types of nurses our patients need. And I have tried... the guilt i will feel when I do give my notice...will be overwhelming. I have actually applied for 2 positions.. one as a computer liason with ZERO patient contact...and the other in an endo lab. Job #1 is M-F flexible schedule...I make it. Job #2 is 7-3 M-Th.. no holidays, weekends. Either would work right now... I need a break... a BIG break! I appreciate all the support! THANK YOU!!!!